Fragmented QRS complex in acute anterior myocardial infarction and coronary sinus blood flow: is there any relevance?

Patients with QRS fragmentation following myocardial infarction [MI] are at greater risk of cardiac death. Transthoracic echocardiography [TTE] can be used as a method for evaluating the coronary sinus blood flow [CSBF] and coronary sinus velocity time integral [CSVTI]. The present study reports measurement of CSBF and CSVTI by TTE in 100 acute anterior MI cases, half of them with fragmented QRS. Our study included 100 patients with acute anterior MI in whom CSBF and CSVTI were measured by the use of TTE. Fifty of all the patients had fragmented QRS complex and 50 patients were without fragmented QRS complex, while there was no difference in terms of LVEF in both groups of study. CSBF [303 +/- 126 ml/min vs. 258 +/- 121 ml/min; p-0.001] and CSVTI [14.45 +/- 2.85 ml vs. 10.85 +/- 2.69 ml; p=0.003] were significantly lower in the acute anterior MI patients with fragmented QRS in comparison with the patients with acute anterior MI without fragmented QRS. We conclude that CSBF and CSVTI can be measured by TTE in acute MI patients and these variables are reduced in acute anterior MI patients with fragmented QRS

Comparison of oxidative stress content during on-pump and off-pump coronary artery bypass surgery

In contrast to conventional on-pump coronary artery bypass grafting [CABG] surgery only mild increase of parameters of oxidative stress is reported during and after off-pump coronary artery bypass grafting. In this study, we attempted to determine the role of off-pump CABG in the myocardial and systemic inflammatory responses. One hundred patients who underwent elective CABG were divided to three groups: I] patients underwent off- pump CABG or 2] on-pump CABG surgery with controlled reperfusion and 3] on-pump CABG with noncontrolled reperfusion. We took patients systemic venous blood samples for the measurement of serum level malondialde hyde [MDA], Troponin [cTnI] and total antioxidant [TAC] and blood level superoxiddismotas [SOD], before and after Ischemia and reperfusion. Mean values of decrease left ventricular ejection fraction [LVEF] after surgery in patients group 3 were higher than patients group2 and also [LVEF] in patients group2 were higher than patients group l [P

Prevalence and intensity of hyperglycemia in non-diabetic patients undergoing coronary artery bypass graft surgery with and without cardiopulmonary bypass

To study the prevalence and severity of hyperglycemia in nondiabetic patients undergoing cardiac operation. In an observational prospective study, 282 non-diabetic patients underwent elective off-pump [n=101] or on-pump [n=181] coronary artery bypass grafting [CABG] surgery from March 2006 to July 2007 in Madani Heart Hospital, Tabriz, Iran. Blood glucose [BG] levels were measured during and 24 hours after operation. Frequencies of hyperglycemia [BG >/= 126 mg/dl] and severe hyperglycemia [BG >/= 180 mg/dl] and postoperative complications were compared in the 2 study groups. Prevalence of at least one episode of severe hyperglycemia was 54.6% [154/282] in our patients during, and 24 hours after operation. Intra-operative hyperglycemia was slightly higher in on-pump group. Frequency of post-operative hyperglycemia was higher, although not significantly different between the 2 groups. The 2 study groups were not significantly different in frequency of severe hyperglycemia during operation, although were different within 24 hours postoperative period. Prevalence of hyperglycemia especially severe hyperglycemia was high during, and after operation in both off-pump and on-pump CABG in non-diabetic patients. There was a borderline difference in blood glucose level between on-pump and off-pump CABG patients. It may be prudent to consider glycemic control protocols in these patients especially in early post-operative period

Non invasive assessment of myocardial perfusion after first myocardial infarction with transthoracic echocardiography

Standard methods for the measurement of myocardial perfusion are invasive and require cardiac catheterization or the use of radioisotope dyes. The coronary sinus blood flow [CSBF] is an appropriate criterion for the efficacy of myocardial perfusion. This study sought to measure CSBF via transthoracic echocardiography [TTE] in patients with acute myocardial infarction [AMI] and to assess its relation with left ventricular ejection fraction [LVEF], wall motion scoring index [WMSI], and in-hospital mortality. This case-control study evaluated 20 patients [pts] with anterior AMI and 20 healthy individuals as controls over a 6-month period [in 2005] in Madani Heart Center in Tabriz [Iran]. All the patients received the same drugs for AMI treatment [e.g. fibrinolytic]. CSBF and WMSI, having been obtained via TTE, were compared between the two groups. Baseline variables were similar between the two groups [P>0.05]. CSBF in the AMI group was 287.8 +/- 128 ml/ min and in the control group was 415_127 ml/min [P=0.001]. There was a significant correlation between CSBF and LVEF [r=0.52, P=0.01], between CSBF and WMSI [r=-0.77, P=0.0001], and between CSBF and in-hospital mortality [r=0.58, P=0.03]. Our study demonstrated a good correlation between CSBF measured with 2D-doppler TTE and LVEF, WMSI, and in-hospital mortality

Cisatracurium in cardiac surgery - continuous infusion vs. bolus administration

The aim of this study was the comparison of infusion vs. intermittent bolus administration of cisatracurium [CA] following cardiac surgery with regard to total intraoperative dose and time of recovery from neuromuscular blockade. From June 2005 to April 2006 sixty ASA II-III patients who were undergoing coronary bypass graft and valve replacement surgery, were equally divided and randomized to receive either intermittent bolus [Group A, n = 30] or continuous infusion [Group B, n = 30] of CA in Madani Heart Center in the Tabriz [Iran]. Total intraoperative dose of CA and time to TOF ratio = 0.8 after operation were measured. Anesthesia technique in two groups was the same. All of the patients underwent cardiopulmonary bypass. Intensity of neuromuscular blockade maintained on one train-of-four [TOF] twitch response of adductor pollicis during operation. Mean received dose of CA was 32.8 +/- 20.6 micro/kg/hr in Group A and 89.7 +/- 39.4 micro/kg/hr in Group B [p = 0.003]. Total intraoperative dose of CA was 23.6 +/- 4.9 mg in Group A and 39.2 +/- 10.1 mg in Group B [p = 0.001]. Spontaneous recovery from neuromuscular blockade in ICU [TOF ratio = 0.8] was reached in 43.8 +/- 9.2 min in Group A, and 64.2 +/- 15.1 min in Group B [p = 0.0001]. Intubation time in ICU was not significantly different [Group A = 8.3 +/- 5.1 hrs vs. Group B = 10.2 +/- 6.2 hrs, p = 0.256]. These results support the intermittent bolus administration of cisatracurium in cardiac surgery following cardiopulmonary bypass